Functional Results of Dental Restoration with Osseointegrated Implants after Mandible Reconstruction

Abstract

We reviewed the cases of 20 cancer patients (mean age 47.4 years) in whom osseointegrated implants were used for dental restoration after mandibular reconstruction between January of 1988 and December of 1994. Seventy-one implants were placed into bone flaps (n = 60) or native mandible (n = 11), an average of 3.55 per patient (range, 2 to 5). Successful integration occurred in 91.5 percent (65 of 71); there were five early failures and one late failure, with no significant difference between the number lost in microvascular flaps (5 of 60) and native mandible (1 of 11) (as determined by Fisher's exact test). Functional evaluation included assessments of diet, speech, and cosmesis. Based on our review, we concluded that (1) implants enhance dental restoration in selected patients, and (2) microvascular bone flaps, including the fibula and iliac crest, are well suited for dental implant restoration.

Clinical and Functional Outcomes of Implant Prostheses in Fibula Free Flaps

“…The survival rate of fibula flaps in this case series was 100% which was higher than those results reported by other authors. [1][2][3]10,11,13,15,17,30 We followed a delayed loading protocol for all implants in this case series although excellent primary stability has been cited as a reason for immediate loading of implants in fibula free flaps. 31 Implant survival rate in our study was 100%, which was higher than previous studies and implant success rate in our study was 94%, which was lower than previous studies.…”

“…31 Implant survival rate in our study was 100%, which was higher than previous studies and implant success rate in our study was 94%, which was lower than previous studies. 10,19,23,24,26 Data regarding the usefulness of implant prosthodontic treatment in the functional rehabilitation of patients with jaw defects reconstructed with fibula free flaps are lacking. 20 In this study, 80% of the patients could not chew properly on both sides although only one patient had limitations in the consistency of food she could consume.…”

“…This was consistent with the results obtained in one other study, but was higher than those of other reports which ranged between 0 and 12%. 7,9,10,20 There is no general agreement that endosseous implants should fail to a higher degree due to irradiation. 33 Radiation exceeding 50 Gy can cause destruction of capillaries, proliferative endarteritis, damage to osteoprogenitor cells, and overall reduced neovascularity, which can impair the process of osseointegration.…”

“…4 Research in this field has mainly focused on the survival rate of the flap and postoperative complications. [5][6][7][8][9][10] The ultimate goal of such a surgical reconstruction should be functional dental prosthetic rehabilitation, placing dental implants in the reconstructed area may overcome problems related to dental rehabilitation with removable prostheses. [11][12][13][14] Fibular bone presents favorable conditions for implant placement, and subsequent implant supported prosthetic rehabilitation, due to its diameter and the good quality of its cortical bone.…”

Rehabilitation of Partial Mandibulectomy Using Implant-Supported Removable Prosthesis in an Irradiated Patient: Case Report

“…8 Placement of osseointegrated implants with a second stage surgery may be beneficial to perform blood supply of the bone flap which might be compromised at the primary surgery due to osteotomies and hardware placement. 9 Although implant supported prostheses provide appropriate retantion and stabilization on the resected patients, increasing the surgical stages may not be favorable on the irradiated jaws. However, studies showed that insertion of an implant into irradiated mandible neither affects the osseoeintegration period nor the survival rate.…”